What is Asperger's syndrome?

Asperger's syndrome is a developmental disorder that is considered an ASD, i.e. an autism spectrum disorder. It impacts, among other things, on the individual's ability to communicate and socialize.

What is Asperger's syndrome?

When people meet, they make judgments about each other. People's body language, facial expressions and tone of voice give out information regarding whether they are happy, sad, angry or in a hurry. The way we respond depends on how we process these signals.

For a person with Asperger's syndrome, reading these signals instinctively is more difficult. Consequently, they find it more difficult to communicate and interact with others. According to the National Autistic Society in the UK, this can lead to anxiety and confusion.

Asperger's syndrome differs from other ASDs in that the symptoms are less severe and there is no language delay. A child with AS generally has good language and cognitive (thinking, intelligence) skills. They tend to have average or above-average vocabularies and reach speech milestones at the same time as children in the general population. The Autism Society in Maryland, USA, says that most people who are unfamiliar with AS may just think that the individual is behaving differently.

A child with autism is usually perceived as aloof and not interested in mixing in with others. Children with AS, however, generally want to interact with others. The problem is that they find it hard.

The individual with AS may find it hard to understand conventional social rules and may come over as lacking empathy. Their usage of gestures may appear either lacking or inappropriate, and eye contact may be very limited. Unlike other children (and adults) with an ASD, those with AS (Asperger's syndrome) have average IQs and are pretty much just as likely to have learning disabilities as those without AS. However, their learning requirements may be different than that of other children.

Asperger's syndrome was named after Austrian pediatrician Hans Asperger, who first described the disorder in 1944. However, the syndrome was not recognized as a distinct disorder until later on. A child with AS may show signs of the disorder during the first year of life. Parents or caregivers may sense that there is something unusual about their infant - their motor skills may appear uncoordinated, the way they crawl or walk might be awkward or clumsy, or just slightly different. As the baby grows into a toddler, there may be a certain amount of clumsiness.

Asperger's syndrome is not a disease, it is a syndrome. A syndrome is a collection of symptoms that occur together with a condition. People with AS have the same life expectancy as in the general population, and are no more or less susceptible to diseases or infections as others. The likelihood of developing depression later on in life is higher for those with AS, but this is probably a consequence of years of living with the stresses and anxieties that come with coping with life in a "non-AS" world.

Signs and symptoms of Asperger's syndrome

What is the difference between a sign and a symptom? A symptom is something only the patient feels and describes, such as a headache or blurry vision, while a sign can be detected by other people, such as inflammation, dilated pupils, or a rash.

Asperger's syndrome is a wide spectrum disorder: This means that not all people have the same symptoms; they vary enormously from person-to-person. Below are some of the most common signs and symptoms:

Obsessive interests: Some children with Asperger's syndrome have become experts in a single object or topic. This often excludes any other subject. This compulsive interest can range from vacuum cleaners, car models, trains, computers or even objects as strange as kitchen equipment or lawn mowers. These activities usually involve collecting, numbering or listing.

Speech is formal or distinct: there may be a lack of rhythm or intonation in how a person with AS speaks. Their utterances may come out as flat, monotonous, or unusually slow or fast.

Children with AS commonly lack the ability to modulate the pitch of their voice to match their immediate surroundings. Sometimes there may be a problem in using the right amount of volume. They may often sound much older than they are. Teachers or family members may describe their speech as that of a "little professor".

Routines: In an effort to lessen confusion, people with AS may have rules and rituals which they methodically maintain. They are easily anxious and upset if there is a disruption to their set of patterns. Parents and adults with AS say that the ability to adapt to change is there, even a change of routine, as long as the person knows well in advance. A surprise change in routine can sometimes cause upset or anxiety.

Social isolation: Adults and children with Asperger's syndrome are often isolated because of their poor social skills and narrow interests, i.e. they end up often being alone. They can become withdrawn and seem uninterested in other people, appearing distant or aloof. Normal conversation may be challenging, because of inappropriate and/or odd behavior. There is a tendency to only talk about their singular interest. Making friends, as well as keeping them is often a problem.

In many cases, the person wants to have friends and mix in, but finds it hard. After trying and trying without much success, there is a risk the child (and adult) may find it safer and less troublesome to be alone. However, being alone might not be ideal. Contact with others, "brushing" with others in our herd, helps people with AS overcome some of their difficulties.

Delay in motor skills: Usually, children with Asperger's syndrome have developmental delays in motor skills, such as pedaling a bike, running, catching a ball, playing ball games, or climbing. They are often clumsy and poorly coordinated. Carrying out specific detailed tasks, such as tying shoelaces may require extra effort. The way they walk can appear either stiff or bouncy. Arms may not swing while walking, but just hang down (like they would if one were carrying shopping).

Social skills and communication. Sometimes, people with Asperger's syndrome have difficulty to express themselves emotionally and socially. They find it difficult to understand and interpret gestures, facial expressions or tone of voice. They lack the basic social skills most other people take for granted. The natural ability of knowing when to start or end a conversation may be weak. They do not easily understand jokes, humor, figures of speech and irony.

The Asperger's Association of New England explains that people with AS do not pick up much of the non-verbal social cues conveyed to them. They may simply not be aware of this information, while the cues that they do notice are commonly misinterpreted. This can result in "frustratingly awkward social interactions and ineffective behavioral responses."

Imagination: People with this syndrome can have difficulty with social imagination. They may have trouble imagining alternative outcomes to situations. Make-believe games may seem pointless, impossible to do, or ridiculous.

Topics based on logic, memory and systems are more interesting (mathematics, computer science and music). Many children with Asperger's syndrome are exceptionally talented or skilled in those particular areas.

Sensory difficulties: In some individuals, the sensory sensitivity is distorted. One or all of the senses (sight, sound, smell, touch, or taste) can be altered. The senses are either intensified or underdeveloped. People with the syndrome might have different perceptions of loud noises, bright lights, intense smells, food textures and materials. Many people with AS say that if they know a noise or smell is going to come, they can cope with them well - often, it is an unexpected sensation that causes distress.

Related conditions. In early childhood, children with Asperger's syndrome are often extremely active. Later, in young adulthood they may develop anxiety or depression. Other conditions related with the syndrome are Attention Deficit Hyperactivity Disorder (ADHD), depression, tic disorders (such as Tourette syndrome), anxiety disorders, and Obsessive-compulsive disorder (OCD).

People with Asperger's syndrome are orderly and pay attention to detail (Rainer Sturm/pixelio.de)

What are the treatment options for Asperger's syndrome?

Currently, there is no way of reversing Asperger's syndrome. But there are several therapies and strategies that can improve functioning, reduce anxiety, and improve behaviors and the perception and delivery of data and events. With the increasing understanding of the syndrome, people with AS today have a better chance of reaching their full potential.

A combination of therapies, teaching of strategies, and some other approaches can have a significant impact on the quality of life of a person with Asperger's syndrome. Problems and issues related with routines, obsessive thoughts and behaviours, communication skills, inhibition, dexterity, clumsiness, anxiety, etc. may include the following:

Acquiring more suitable social skills - the individuals learns how to interact more effectively and successfully with other people. The approach focuses on the ability to understand other people's feelings and respond accordingly. This training teaches how to read and respond appropriately to social cues. It is possible to learn how to improve one's empathy.

Communication skills training: This training helps develop the ability to start conversations. This can include specialized speech and language therapy to help handling normal conversations. Learning how to use intonation in the interrogative, affirmative, negative and imperative forms can help a person with AS considerably. Also, learning how to interpret language, verbal and non-verbal, in order to know how to respond or interact properly helps the person with AS become less isolated.

Cognitive behavioral therapy: This therapy focuses on learning to control emotions and decrease obsessive interests and repetitive routines.

Behavior modification: This includes strategies for supporting positive behavior and decreasing problem behavior.

Occupational or physical therapy: This can be useful for individuals with sensory integration problems or poor motor coordination.

Medication: There are no medications to treat Asperger's syndrome itself. Drugs may be used to treat particular symptoms and co-existing conditions (depression, anxiety, hyperactivity, obsessive-compulsive behavior).

Alternative medicine: Some studies suggest that special diets, such as gluten-free diets and vitamin supplements can be beneficial. Anecdotal evidence suggests that a regular intake of fish oils may help with anxiety, and some cognitive issues.Training and providing support to parents, caregivers and other household members is important. Sometimes people in the household, usually the parents, may need emotional and psychological support themselves - especially if diagnosis did not occur early.

Education and academic skills: some children with AS benefit from an educational approach that provides them not only with certain kinds of support, such as organizing notes, homework, timetables, but also certain learning needs. If the approach is well organized, long-term, and carried out by trained professionals, the child will most likely do well in a mainstream school environment.

Although the core characteristics of Asperger's syndrome will be there for life, the majority of children with AS can lead happy and fruitful lives, well into adulthood and old age. Early intervention and support significantly increase this likelihood.With a keen eye and understanding, parents can learn what makes a child with Asperger's syndrome thrive, and what has the opposite effect. Unless otherwise told to do so by an expert, avoid situations which may distress or upset the child. Make sure the child is aware of any changes in routine, teach him/her what acceptable and unacceptable is, practice them and provide vital feedback.